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Doug Brunk is a San Diego-based award-winning reporter who began covering health care in 1991. Before joining the company, he wrote for the health sciences division of Columbia University and was an associate editor at Contemporary Long Term Care magazine when it won a Jesse H. Neal Award. His work has been syndicated by the Los Angeles Times and he is the author of two books related to the University of Kentucky Wildcats men's basketball program. Doug has a master’s degree in magazine journalism from the S.I. Newhouse School of Public Communications at Syracuse University. Follow him on Twitter @dougbrunk.
Poor parent-infant relationship may affect a child’s motor skill development
TORONTO – In what is believed to be a landmark finding, researchers have shown than modifiable risk factors, such as parent-infant relationships, may play a role in preventing children from developing high motor problems during early life.
“Our findings suggest that early health and clinical problems, such as neonatal complications and abnormal neonatal neurological status, are useful indicators to help identify children at risk of poor motor development,” lead study author Nicole Baumann said in an interview in advance of the Pediatric Academic Societies meeting. “Additionally, as a possible implication, children may benefit in motor development from early interventions that incorporate and focus on improving parent-infant relationships.”
For the current study, she and her associates investigated motor development using data from two different cohorts: the Bavarian Longitudinal Study in Germany (BLS) and the Arvo Ylppö Longitudinal Study in Finland (AYLS). A total of 4,741 and 1,423 children, respectively, underwent assessment from birth to age 56 months. Motor functioning was evaluated via standard physical and neurological assessments at birth and at 5, 20, and 56 months. Perinatal, neonatal, and early environmental information was collected at birth and at 5 months via medical records and reports from parents and research nurses.
The researchers identified two distinct trajectories of motor development problems from birth to 56 months: low (94.3% of BLS and 97.3% of AYLS) and high (5.7% of BLS and 2.7% of AYLS) motor problems.
In the BLS cohort, high motor problem trajectory was predicted by poor parent-infant relationship, such as the mother feeling insecure when taking care of the infant at home (OR 1.52); abnormal neonatal neurological status (odds ratio, 1.16); neonatal complications (OR, 1.12); and duration of initial hospitalization (OR, 1.02).
In the AYLS cohort, high motor problem trajectory was also predicted by abnormal neonatal neurological status (OR, 1.69) and duration of hospitalization (OR, 1.02). Although neonatal complications (OR, 1.08) and poor parent-infant relationship (OR, 1.09) did not significantly predict high motor problem trajectory in the AYLS cohort, trends identified were comparable with those obtained from the BLS cohort.
“Most surprising was that one of the four risk factors that remained as independent predictors of high motor problem trajectory was poor parent-infant relationship,” Ms. Baumann said. “As far as we are aware, parent-infant relationship has not been previously reported as a predictor of poor motor development.”
She acknowledged certain limitations of the study, including the fact that nearly 33% of children could not be assessed throughout the study period because of dropout. “Families with children who had poor health and were socially disadvantaged were less likely to continue participation, and may even suggest that our findings have an even larger effect than reported,” Ms. Baumann said. “This is a problem that affects many longitudinal studies, and it may affect group comparisons. However, simulations have shown that even when dropout is selective or correlated with the outcome that predictions only marginally change (Br J Psychiatry. 2009;195[3]:249-56).”
She reported having no financial disclosures.
TORONTO – In what is believed to be a landmark finding, researchers have shown than modifiable risk factors, such as parent-infant relationships, may play a role in preventing children from developing high motor problems during early life.
“Our findings suggest that early health and clinical problems, such as neonatal complications and abnormal neonatal neurological status, are useful indicators to help identify children at risk of poor motor development,” lead study author Nicole Baumann said in an interview in advance of the Pediatric Academic Societies meeting. “Additionally, as a possible implication, children may benefit in motor development from early interventions that incorporate and focus on improving parent-infant relationships.”
For the current study, she and her associates investigated motor development using data from two different cohorts: the Bavarian Longitudinal Study in Germany (BLS) and the Arvo Ylppö Longitudinal Study in Finland (AYLS). A total of 4,741 and 1,423 children, respectively, underwent assessment from birth to age 56 months. Motor functioning was evaluated via standard physical and neurological assessments at birth and at 5, 20, and 56 months. Perinatal, neonatal, and early environmental information was collected at birth and at 5 months via medical records and reports from parents and research nurses.
The researchers identified two distinct trajectories of motor development problems from birth to 56 months: low (94.3% of BLS and 97.3% of AYLS) and high (5.7% of BLS and 2.7% of AYLS) motor problems.
In the BLS cohort, high motor problem trajectory was predicted by poor parent-infant relationship, such as the mother feeling insecure when taking care of the infant at home (OR 1.52); abnormal neonatal neurological status (odds ratio, 1.16); neonatal complications (OR, 1.12); and duration of initial hospitalization (OR, 1.02).
In the AYLS cohort, high motor problem trajectory was also predicted by abnormal neonatal neurological status (OR, 1.69) and duration of hospitalization (OR, 1.02). Although neonatal complications (OR, 1.08) and poor parent-infant relationship (OR, 1.09) did not significantly predict high motor problem trajectory in the AYLS cohort, trends identified were comparable with those obtained from the BLS cohort.
“Most surprising was that one of the four risk factors that remained as independent predictors of high motor problem trajectory was poor parent-infant relationship,” Ms. Baumann said. “As far as we are aware, parent-infant relationship has not been previously reported as a predictor of poor motor development.”
She acknowledged certain limitations of the study, including the fact that nearly 33% of children could not be assessed throughout the study period because of dropout. “Families with children who had poor health and were socially disadvantaged were less likely to continue participation, and may even suggest that our findings have an even larger effect than reported,” Ms. Baumann said. “This is a problem that affects many longitudinal studies, and it may affect group comparisons. However, simulations have shown that even when dropout is selective or correlated with the outcome that predictions only marginally change (Br J Psychiatry. 2009;195[3]:249-56).”
She reported having no financial disclosures.
TORONTO – In what is believed to be a landmark finding, researchers have shown than modifiable risk factors, such as parent-infant relationships, may play a role in preventing children from developing high motor problems during early life.
“Our findings suggest that early health and clinical problems, such as neonatal complications and abnormal neonatal neurological status, are useful indicators to help identify children at risk of poor motor development,” lead study author Nicole Baumann said in an interview in advance of the Pediatric Academic Societies meeting. “Additionally, as a possible implication, children may benefit in motor development from early interventions that incorporate and focus on improving parent-infant relationships.”
For the current study, she and her associates investigated motor development using data from two different cohorts: the Bavarian Longitudinal Study in Germany (BLS) and the Arvo Ylppö Longitudinal Study in Finland (AYLS). A total of 4,741 and 1,423 children, respectively, underwent assessment from birth to age 56 months. Motor functioning was evaluated via standard physical and neurological assessments at birth and at 5, 20, and 56 months. Perinatal, neonatal, and early environmental information was collected at birth and at 5 months via medical records and reports from parents and research nurses.
The researchers identified two distinct trajectories of motor development problems from birth to 56 months: low (94.3% of BLS and 97.3% of AYLS) and high (5.7% of BLS and 2.7% of AYLS) motor problems.
In the BLS cohort, high motor problem trajectory was predicted by poor parent-infant relationship, such as the mother feeling insecure when taking care of the infant at home (OR 1.52); abnormal neonatal neurological status (odds ratio, 1.16); neonatal complications (OR, 1.12); and duration of initial hospitalization (OR, 1.02).
In the AYLS cohort, high motor problem trajectory was also predicted by abnormal neonatal neurological status (OR, 1.69) and duration of hospitalization (OR, 1.02). Although neonatal complications (OR, 1.08) and poor parent-infant relationship (OR, 1.09) did not significantly predict high motor problem trajectory in the AYLS cohort, trends identified were comparable with those obtained from the BLS cohort.
“Most surprising was that one of the four risk factors that remained as independent predictors of high motor problem trajectory was poor parent-infant relationship,” Ms. Baumann said. “As far as we are aware, parent-infant relationship has not been previously reported as a predictor of poor motor development.”
She acknowledged certain limitations of the study, including the fact that nearly 33% of children could not be assessed throughout the study period because of dropout. “Families with children who had poor health and were socially disadvantaged were less likely to continue participation, and may even suggest that our findings have an even larger effect than reported,” Ms. Baumann said. “This is a problem that affects many longitudinal studies, and it may affect group comparisons. However, simulations have shown that even when dropout is selective or correlated with the outcome that predictions only marginally change (Br J Psychiatry. 2009;195[3]:249-56).”
She reported having no financial disclosures.
AT PAS 2018
Key clinical point: Four risk factors are independent predictors of high motor problem trajectory in young children.
Major finding: In the Bavarian Longitudinal Study cohort, high motor problem trajectory was predicted by abnormal neonatal neurological status (odds ratio, 1.16), duration of initial hospitalization (OR 1.02), neonatal complications (OR 1.12), and poor parent-infant relationship (OR 1.52).
Study details: A longitudinal analysis of 4,741 children from the Bavarian Longitudinal Study in Germany and 1,423 children from the Arvo Ylppö Longitudinal Study in Finland.
Disclosures: Ms. Baumann reported having no financial disclosures.
ED visits higher among pediatric asthma patients with comorbid depression, anxiety
TORONTO – Children with asthma who have a comorbid diagnosis of anxiety or depression are significantly more likely to make asthma-related visits to the emergency department, compared with their peers who do not have a mental health condition, results from a large administrative data analysis showed.
“There has been a fair bit of research on how comorbid mental health conditions can affect health care utilization for asthma in adults, but few studies have examined how comorbid mental health conditions like anxiety or depression can affect children with asthma,” one of the study authors, Caroline Neel, said in an interview in advance of the Pediatric Academic Societies meeting.
In all, the researchers identified 71,326 patients with asthma, with an overall rate of 16.3 ED visits per 100 child-years. Among these, children with a diagnosis of depression had significantly higher rates of ED visits (21.5 visits per 100 child-years; P less than .01), as did those with a diagnosis of anxiety (19.5 ED visits per 100 child-years; P less than .01). Being enrolled in a Medicaid managed care plan or Medicaid fee-for-service plan also increased the rates of asthma-related ED visits (20.3 and 21.5 ED visits per 100 child-years, respectively; P less than .01 for both associations.)
“We were surprised to see that anxiety and depression seemed to increase asthma emergency department visits as much as other medical chronic illnesses like cystic fibrosis or sickle cell disease, and that kids on Medicaid, who tend to be our poorer kids, also had an independent risk of going to the emergency department,” Ms. Neel said. “Having Medicaid as well as anxiety or depression were independently related to going to the emergency room for asthma, so the study suggests that some of our highest-risk kids for asthma have multiple different contributors to getting sick and needing to go to the emergency room for an asthma attack.”
She acknowledged certain limitations of the analysis, including its reliance on administrative claims data to identify whether or not children had a diagnosis of anxiety or depression. “This doesn’t necessarily identify all the kids who may have these mental health conditions, since sometimes providers are less likely to document a diagnosis of a mental health conditions for children,” she said. “However, we still saw a significant association between a comorbid mental health condition and emergency department use for asthma, despite the potential that mental health conditions may have been under reported.”
The study’s senior author was Naomi Bardach, MD. The researchers reported having no financial disclosures.
TORONTO – Children with asthma who have a comorbid diagnosis of anxiety or depression are significantly more likely to make asthma-related visits to the emergency department, compared with their peers who do not have a mental health condition, results from a large administrative data analysis showed.
“There has been a fair bit of research on how comorbid mental health conditions can affect health care utilization for asthma in adults, but few studies have examined how comorbid mental health conditions like anxiety or depression can affect children with asthma,” one of the study authors, Caroline Neel, said in an interview in advance of the Pediatric Academic Societies meeting.
In all, the researchers identified 71,326 patients with asthma, with an overall rate of 16.3 ED visits per 100 child-years. Among these, children with a diagnosis of depression had significantly higher rates of ED visits (21.5 visits per 100 child-years; P less than .01), as did those with a diagnosis of anxiety (19.5 ED visits per 100 child-years; P less than .01). Being enrolled in a Medicaid managed care plan or Medicaid fee-for-service plan also increased the rates of asthma-related ED visits (20.3 and 21.5 ED visits per 100 child-years, respectively; P less than .01 for both associations.)
“We were surprised to see that anxiety and depression seemed to increase asthma emergency department visits as much as other medical chronic illnesses like cystic fibrosis or sickle cell disease, and that kids on Medicaid, who tend to be our poorer kids, also had an independent risk of going to the emergency department,” Ms. Neel said. “Having Medicaid as well as anxiety or depression were independently related to going to the emergency room for asthma, so the study suggests that some of our highest-risk kids for asthma have multiple different contributors to getting sick and needing to go to the emergency room for an asthma attack.”
She acknowledged certain limitations of the analysis, including its reliance on administrative claims data to identify whether or not children had a diagnosis of anxiety or depression. “This doesn’t necessarily identify all the kids who may have these mental health conditions, since sometimes providers are less likely to document a diagnosis of a mental health conditions for children,” she said. “However, we still saw a significant association between a comorbid mental health condition and emergency department use for asthma, despite the potential that mental health conditions may have been under reported.”
The study’s senior author was Naomi Bardach, MD. The researchers reported having no financial disclosures.
TORONTO – Children with asthma who have a comorbid diagnosis of anxiety or depression are significantly more likely to make asthma-related visits to the emergency department, compared with their peers who do not have a mental health condition, results from a large administrative data analysis showed.
“There has been a fair bit of research on how comorbid mental health conditions can affect health care utilization for asthma in adults, but few studies have examined how comorbid mental health conditions like anxiety or depression can affect children with asthma,” one of the study authors, Caroline Neel, said in an interview in advance of the Pediatric Academic Societies meeting.
In all, the researchers identified 71,326 patients with asthma, with an overall rate of 16.3 ED visits per 100 child-years. Among these, children with a diagnosis of depression had significantly higher rates of ED visits (21.5 visits per 100 child-years; P less than .01), as did those with a diagnosis of anxiety (19.5 ED visits per 100 child-years; P less than .01). Being enrolled in a Medicaid managed care plan or Medicaid fee-for-service plan also increased the rates of asthma-related ED visits (20.3 and 21.5 ED visits per 100 child-years, respectively; P less than .01 for both associations.)
“We were surprised to see that anxiety and depression seemed to increase asthma emergency department visits as much as other medical chronic illnesses like cystic fibrosis or sickle cell disease, and that kids on Medicaid, who tend to be our poorer kids, also had an independent risk of going to the emergency department,” Ms. Neel said. “Having Medicaid as well as anxiety or depression were independently related to going to the emergency room for asthma, so the study suggests that some of our highest-risk kids for asthma have multiple different contributors to getting sick and needing to go to the emergency room for an asthma attack.”
She acknowledged certain limitations of the analysis, including its reliance on administrative claims data to identify whether or not children had a diagnosis of anxiety or depression. “This doesn’t necessarily identify all the kids who may have these mental health conditions, since sometimes providers are less likely to document a diagnosis of a mental health conditions for children,” she said. “However, we still saw a significant association between a comorbid mental health condition and emergency department use for asthma, despite the potential that mental health conditions may have been under reported.”
The study’s senior author was Naomi Bardach, MD. The researchers reported having no financial disclosures.
Key clinical point: Anxiety and depression are associated with higher rates of ED use in children with asthma.
Major finding: (21.5 visits per 100 child-years; P less than .01), as did those with a diagnosis of anxiety (19.5 ED visits per 100 child-years; P less than .01).
Study details: An analysis of 71,326 patients with asthma from the Massachusetts All Payer Claims Database for 2014-2015.
Disclosures: The researchers reported having no financial disclosures.
Collagen remodeling observed after laser treatment in EB patient
DALLAS – Fractional led to considerable clinical improvement, including thickening of the dermis, results from a case report showed.
“We have so much more to learn about how the laser treatments are modifying these intricate pathways,” lead study author Samantha Schneider, MD, said in an interview following the annual conference of the American Society for Laser Medicine and Surgery. “But, our project suggests that patients with genetic blistering diseases may benefit from fractional laser therapy in combination with topical PLLA. This may be a good option, particularly for patients who are looking for more therapeutic options for slowly healing wounds and have exhausted other more conventional treatment modalities.”
Drawing from this previous work, Dr. Schneider and her associates hypothesized that fractional ablative laser treatment and topical PLLA might help a 27-year-old RDEB patient with revertant mosaicism who presented for management of large, nonhealing erosions on her upper back and posterior neck, complicated by frequent Staphylococcus infections. Over a 2-year period the researchers administered 15 fractional CO2 laser treatments with a single-pulse, nonoverlapping technique with settings of 15 mJ of energy and 15% density. They immediately applied concentrated topical PLLA to the treated area and obtained punch biopsy specimens from treated and untreated affected skin and clinically normal-appearing skin after the seventh treatment for histopathologic and immunohistologic examination.
Since the time of treatment, the patient reported marked improvement with a decreased number of erosions, as well as decreased pain. In addition, the hematoxylin and eosin slides showed increased collagen I (mature collagen) in the treated sample, “which suggests that we may be inducing a type of neocollagenesis, which is exciting particularly if it seems to work for patients with genetic alterations in collagen,” Dr. Schneider said. “Additionally, the indirect immunofluorescence [IIF] showed increased collagen VII, which is absent in the patient’s untreated skin. This was truly surprising and warrants more investigation as to how we may be affecting patients’ biology with this combination treatment.”
She acknowledged that more studies are required to confirm the findings. “Furthermore, we did not examine the fractional laser therapy and the topical PLLA independently so we cannot say whether the effect is synergistic or due primarily to one modality versus the other,” she noted. “Lastly, the IIF interpretation was challenging particularly in the untreated skin due to the epidermal detachment and edge staining. However, when viewed in comparison to the treated skin, we noted increased collagen VII in the treated sample.”
Dr. Schneider reported having no relevant disclosures.
DALLAS – Fractional led to considerable clinical improvement, including thickening of the dermis, results from a case report showed.
“We have so much more to learn about how the laser treatments are modifying these intricate pathways,” lead study author Samantha Schneider, MD, said in an interview following the annual conference of the American Society for Laser Medicine and Surgery. “But, our project suggests that patients with genetic blistering diseases may benefit from fractional laser therapy in combination with topical PLLA. This may be a good option, particularly for patients who are looking for more therapeutic options for slowly healing wounds and have exhausted other more conventional treatment modalities.”
Drawing from this previous work, Dr. Schneider and her associates hypothesized that fractional ablative laser treatment and topical PLLA might help a 27-year-old RDEB patient with revertant mosaicism who presented for management of large, nonhealing erosions on her upper back and posterior neck, complicated by frequent Staphylococcus infections. Over a 2-year period the researchers administered 15 fractional CO2 laser treatments with a single-pulse, nonoverlapping technique with settings of 15 mJ of energy and 15% density. They immediately applied concentrated topical PLLA to the treated area and obtained punch biopsy specimens from treated and untreated affected skin and clinically normal-appearing skin after the seventh treatment for histopathologic and immunohistologic examination.
Since the time of treatment, the patient reported marked improvement with a decreased number of erosions, as well as decreased pain. In addition, the hematoxylin and eosin slides showed increased collagen I (mature collagen) in the treated sample, “which suggests that we may be inducing a type of neocollagenesis, which is exciting particularly if it seems to work for patients with genetic alterations in collagen,” Dr. Schneider said. “Additionally, the indirect immunofluorescence [IIF] showed increased collagen VII, which is absent in the patient’s untreated skin. This was truly surprising and warrants more investigation as to how we may be affecting patients’ biology with this combination treatment.”
She acknowledged that more studies are required to confirm the findings. “Furthermore, we did not examine the fractional laser therapy and the topical PLLA independently so we cannot say whether the effect is synergistic or due primarily to one modality versus the other,” she noted. “Lastly, the IIF interpretation was challenging particularly in the untreated skin due to the epidermal detachment and edge staining. However, when viewed in comparison to the treated skin, we noted increased collagen VII in the treated sample.”
Dr. Schneider reported having no relevant disclosures.
DALLAS – Fractional led to considerable clinical improvement, including thickening of the dermis, results from a case report showed.
“We have so much more to learn about how the laser treatments are modifying these intricate pathways,” lead study author Samantha Schneider, MD, said in an interview following the annual conference of the American Society for Laser Medicine and Surgery. “But, our project suggests that patients with genetic blistering diseases may benefit from fractional laser therapy in combination with topical PLLA. This may be a good option, particularly for patients who are looking for more therapeutic options for slowly healing wounds and have exhausted other more conventional treatment modalities.”
Drawing from this previous work, Dr. Schneider and her associates hypothesized that fractional ablative laser treatment and topical PLLA might help a 27-year-old RDEB patient with revertant mosaicism who presented for management of large, nonhealing erosions on her upper back and posterior neck, complicated by frequent Staphylococcus infections. Over a 2-year period the researchers administered 15 fractional CO2 laser treatments with a single-pulse, nonoverlapping technique with settings of 15 mJ of energy and 15% density. They immediately applied concentrated topical PLLA to the treated area and obtained punch biopsy specimens from treated and untreated affected skin and clinically normal-appearing skin after the seventh treatment for histopathologic and immunohistologic examination.
Since the time of treatment, the patient reported marked improvement with a decreased number of erosions, as well as decreased pain. In addition, the hematoxylin and eosin slides showed increased collagen I (mature collagen) in the treated sample, “which suggests that we may be inducing a type of neocollagenesis, which is exciting particularly if it seems to work for patients with genetic alterations in collagen,” Dr. Schneider said. “Additionally, the indirect immunofluorescence [IIF] showed increased collagen VII, which is absent in the patient’s untreated skin. This was truly surprising and warrants more investigation as to how we may be affecting patients’ biology with this combination treatment.”
She acknowledged that more studies are required to confirm the findings. “Furthermore, we did not examine the fractional laser therapy and the topical PLLA independently so we cannot say whether the effect is synergistic or due primarily to one modality versus the other,” she noted. “Lastly, the IIF interpretation was challenging particularly in the untreated skin due to the epidermal detachment and edge staining. However, when viewed in comparison to the treated skin, we noted increased collagen VII in the treated sample.”
Dr. Schneider reported having no relevant disclosures.
Key clinical point: Fractional ablative laser treatment combined with poly-L-lactic acid may aid in the care of certain patients with recessive dystrophic epidermolysis bullosa.
Major finding: Since the time of treatment, the patient reported marked improvement with a decreased number of erosions as well as decreased pain.
Study details: A case report of a 27-year-old recessive dystrophic epidermolysis bullosa patient with revertant mosaicism.
Disclosures: Dr. Schneider reported having no financial disclosures.
Study pits cryolipolysis versus HIFU for fat reduction in the flank region
DALLAS – While cryolipolysis and high-intensity focused ultrasound are both effective at reducing subcutaneous fat in the flank region, cryolipolysis appeared to be less painful and more effective in a small, randomized trial.
Noninvasive subcutaneous fat reduction is becoming increasingly popular, study author Farhaad R. Riyaz, MD, observed at the annual conference of the American Society for Laser Medicine and Surgery. “High-intensity focused ultrasound seems to be less popular than cryolipolysis. It uses sound waves to create heat and is similar in technology to light traveling through a magnifying glass to create heat at a focal point. But the two technologies really haven’t been rigorously compared in the literature,” he added.
Dr. Riyaz and his associates in the division of cutaneous and aesthetic surgery at Northwestern University, Chicago, enrolled 12 healthy female participants with a body mass index between 18 and 30 kg/m2 and moderate fat in the abdomen flanks. In the split-body, parallel-group trial, the subjects were randomized to cryolipolysis on one flank and to high-intensity focused ultrasound (HIFU) on the contralateral side. Study participants were asked to maintain their weight throughout the 12-week study. Treatments were performed at baseline, week 4, and week 8, with a follow-up visit at week 12. The primary outcome was thickness of subcutaneous fat as measured by ultrasound; secondary outcomes included pain, patient-reported improvement, and total circumference of the abdomen and flanks.
The mean age of the 12 participants was 39 years, 8 were white, and most had Fitzpatrick skin types II and IV (33% and 42%, respectively). Dr. Riyaz reported that (P = .0007 and P = .0341, respectively), as measured by diagnostic ultrasound. The researchers noted significantly less fat in the flanks on the sides treated with cryolipolysis, compared with the sides treated with HIFU (P = .007). Study participants reported significantly more pain with HIFU compared with cryolipolysis (P = .0002).
“Although participant-reported improvement in the appearance of their flanks was significant for both treatments [P less than .0001], patients couldn’t appreciate a difference between the side that was treated with HIFU and the side that was treated with cryolipolysis,” Dr. Riyaz said. “In addition, the total abdominal circumference did not change throughout the study for either group.”
He reported having no financial disclosures.
DALLAS – While cryolipolysis and high-intensity focused ultrasound are both effective at reducing subcutaneous fat in the flank region, cryolipolysis appeared to be less painful and more effective in a small, randomized trial.
Noninvasive subcutaneous fat reduction is becoming increasingly popular, study author Farhaad R. Riyaz, MD, observed at the annual conference of the American Society for Laser Medicine and Surgery. “High-intensity focused ultrasound seems to be less popular than cryolipolysis. It uses sound waves to create heat and is similar in technology to light traveling through a magnifying glass to create heat at a focal point. But the two technologies really haven’t been rigorously compared in the literature,” he added.
Dr. Riyaz and his associates in the division of cutaneous and aesthetic surgery at Northwestern University, Chicago, enrolled 12 healthy female participants with a body mass index between 18 and 30 kg/m2 and moderate fat in the abdomen flanks. In the split-body, parallel-group trial, the subjects were randomized to cryolipolysis on one flank and to high-intensity focused ultrasound (HIFU) on the contralateral side. Study participants were asked to maintain their weight throughout the 12-week study. Treatments were performed at baseline, week 4, and week 8, with a follow-up visit at week 12. The primary outcome was thickness of subcutaneous fat as measured by ultrasound; secondary outcomes included pain, patient-reported improvement, and total circumference of the abdomen and flanks.
The mean age of the 12 participants was 39 years, 8 were white, and most had Fitzpatrick skin types II and IV (33% and 42%, respectively). Dr. Riyaz reported that (P = .0007 and P = .0341, respectively), as measured by diagnostic ultrasound. The researchers noted significantly less fat in the flanks on the sides treated with cryolipolysis, compared with the sides treated with HIFU (P = .007). Study participants reported significantly more pain with HIFU compared with cryolipolysis (P = .0002).
“Although participant-reported improvement in the appearance of their flanks was significant for both treatments [P less than .0001], patients couldn’t appreciate a difference between the side that was treated with HIFU and the side that was treated with cryolipolysis,” Dr. Riyaz said. “In addition, the total abdominal circumference did not change throughout the study for either group.”
He reported having no financial disclosures.
DALLAS – While cryolipolysis and high-intensity focused ultrasound are both effective at reducing subcutaneous fat in the flank region, cryolipolysis appeared to be less painful and more effective in a small, randomized trial.
Noninvasive subcutaneous fat reduction is becoming increasingly popular, study author Farhaad R. Riyaz, MD, observed at the annual conference of the American Society for Laser Medicine and Surgery. “High-intensity focused ultrasound seems to be less popular than cryolipolysis. It uses sound waves to create heat and is similar in technology to light traveling through a magnifying glass to create heat at a focal point. But the two technologies really haven’t been rigorously compared in the literature,” he added.
Dr. Riyaz and his associates in the division of cutaneous and aesthetic surgery at Northwestern University, Chicago, enrolled 12 healthy female participants with a body mass index between 18 and 30 kg/m2 and moderate fat in the abdomen flanks. In the split-body, parallel-group trial, the subjects were randomized to cryolipolysis on one flank and to high-intensity focused ultrasound (HIFU) on the contralateral side. Study participants were asked to maintain their weight throughout the 12-week study. Treatments were performed at baseline, week 4, and week 8, with a follow-up visit at week 12. The primary outcome was thickness of subcutaneous fat as measured by ultrasound; secondary outcomes included pain, patient-reported improvement, and total circumference of the abdomen and flanks.
The mean age of the 12 participants was 39 years, 8 were white, and most had Fitzpatrick skin types II and IV (33% and 42%, respectively). Dr. Riyaz reported that (P = .0007 and P = .0341, respectively), as measured by diagnostic ultrasound. The researchers noted significantly less fat in the flanks on the sides treated with cryolipolysis, compared with the sides treated with HIFU (P = .007). Study participants reported significantly more pain with HIFU compared with cryolipolysis (P = .0002).
“Although participant-reported improvement in the appearance of their flanks was significant for both treatments [P less than .0001], patients couldn’t appreciate a difference between the side that was treated with HIFU and the side that was treated with cryolipolysis,” Dr. Riyaz said. “In addition, the total abdominal circumference did not change throughout the study for either group.”
He reported having no financial disclosures.
Key clinical point: Both cryolipolysis and high-intensity focused ultrasound (HIFU) are effective at reducing subcutaneous fat in the flank region.
Major finding: At week 12 follow-up, both cryolipolysis and HIFU significantly reduced fat in the flanks, compared with baseline (P = .0007 and P = .0341, respectively), as measured by diagnostic ultrasound.
Study details: A split-body, parallel-group trial in which 12 women were randomized to cryolipolysis on one flank and to HIFU on the contralateral side.
Disclosures: Dr. Riyaz reported having no financial disclosures.
Treatment of basal cell carcinoma with 1064-nm Nd:YAG laser promising
DALLAS – One year after patients underwent treatment of basal cell carcinoma (BCC) with the 1064-nm Nd:YAG laser, no recurrences have occurred, according to early results from a study being conducted at two centers.
“ Arisa E. Ortiz, MD, said at the annual conference of the American Society for Laser Medicine and Surgery. “Clearance rates are comparable to or better than other topical modalities such as electrodesiccation and curettage and topical imiquimod. It’s a reasonable alternative for treatment patients with multiple tumors or those who are poor surgical candidates.”
In an ongoing study, she and Mathew M. Avram, MD, director of the Massachusetts General Hospital Dermatology Laser & Cosmetic Center, Boston, have treated 19 superficial, nodular, and pigmented BCC tumors in 11 patients 31-85 years of age. Tumor sizes ranged from 3 mm x 3 mm to 21 mm x 11 mm. Indications for laser treatment have included being a poor surgical candidate (one patient had a history of bleeding complications), having multiple tumors (one patient had Curry-Jones syndrome) – or simply wishing to not undergo surgery. “They didn’t want a surgical scar, or they didn’t want to limit their activity after surgery,” Dr. Ortiz said.
Patients underwent one 1064-nm Nd:YAG laser treatment. The anesthesia was 0.5% lidocaine with no epinephrine. Treatment settings were a 5-mm spot size delivered at a fluence of 140 J/cm2 in a pulse duration of 7-8 milliseconds. The number of pulses ranged from 14 to 36. The immediate endpoint was slight graying and slight contraction. “When you’re using the 1064-nm Nd:YAG for cosmetic purposes, you don’t want to see these endpoints, but we are treating skin cancer, so you do want to see some contraction and graying,” she said. The procedure was covered under insurance and billed as malignant destruction (CPT codes 17260-17266 and 17280-17283).
Dr. Ortiz reported that there have been no recurrences in the 11 patients at 1-year follow-up as determined by clinical observation. “There are many advantages to laser treatment of basal cell carcinoma,” she concluded. “There’s only one treatment visit, so you don’t have to come back for suture removal, and it’s a very quick treatment. There’s no significant downtime or limitation on activities, and there’s minimal wound care – just ointment and a Band-Aid – and relatively decreased risk for complications such as infection or bleeding, and minimal to no scar.”
“Laser surgery also provides precision that ordinary surgical techniques cannot match. Despite the obvious obstacles, there is no reason such surgical techniques cannot be expanded someday to other internal cutaneous tumors, including GI tumors. To some extent this is happening already. Vascular lasers are being used to treat a bleeding disorder of the colon known as angiodysplasia. Cautious exploration of laser- and light-based treatments should be further explored as a means of sparing tissue and surgical morbidity.”
Dr. Ortiz disclosed that she has received grant funding from Sienna and Revance, as well as equipment from BTL, Invasix, and Sciton. She has received consulting fees from Alastin, Merz, and Sciton; honoraria from Alastin, Cutera, Invasix, and Sciton; and she holds ownership interest with Allergan. She also has served on the advisory boards for Alastin, Allergan, Invasix, Rodan + Fields, Sciton, Sienna, and Merz.
Dr. Avram disclosed that he serves on the medical advisory board of Sciton and on the scientific advisory boards of Sienna Biopharmaceuticals, Cytrellis, and Allergan. He is also a consultant for Merz Aesthetics, Allergan, Soliton, Invasix, and Revance and has intellectual property with Cytrellis. He also holds stock options with Cytrellis, Invasix, and Zalea.
DALLAS – One year after patients underwent treatment of basal cell carcinoma (BCC) with the 1064-nm Nd:YAG laser, no recurrences have occurred, according to early results from a study being conducted at two centers.
“ Arisa E. Ortiz, MD, said at the annual conference of the American Society for Laser Medicine and Surgery. “Clearance rates are comparable to or better than other topical modalities such as electrodesiccation and curettage and topical imiquimod. It’s a reasonable alternative for treatment patients with multiple tumors or those who are poor surgical candidates.”
In an ongoing study, she and Mathew M. Avram, MD, director of the Massachusetts General Hospital Dermatology Laser & Cosmetic Center, Boston, have treated 19 superficial, nodular, and pigmented BCC tumors in 11 patients 31-85 years of age. Tumor sizes ranged from 3 mm x 3 mm to 21 mm x 11 mm. Indications for laser treatment have included being a poor surgical candidate (one patient had a history of bleeding complications), having multiple tumors (one patient had Curry-Jones syndrome) – or simply wishing to not undergo surgery. “They didn’t want a surgical scar, or they didn’t want to limit their activity after surgery,” Dr. Ortiz said.
Patients underwent one 1064-nm Nd:YAG laser treatment. The anesthesia was 0.5% lidocaine with no epinephrine. Treatment settings were a 5-mm spot size delivered at a fluence of 140 J/cm2 in a pulse duration of 7-8 milliseconds. The number of pulses ranged from 14 to 36. The immediate endpoint was slight graying and slight contraction. “When you’re using the 1064-nm Nd:YAG for cosmetic purposes, you don’t want to see these endpoints, but we are treating skin cancer, so you do want to see some contraction and graying,” she said. The procedure was covered under insurance and billed as malignant destruction (CPT codes 17260-17266 and 17280-17283).
Dr. Ortiz reported that there have been no recurrences in the 11 patients at 1-year follow-up as determined by clinical observation. “There are many advantages to laser treatment of basal cell carcinoma,” she concluded. “There’s only one treatment visit, so you don’t have to come back for suture removal, and it’s a very quick treatment. There’s no significant downtime or limitation on activities, and there’s minimal wound care – just ointment and a Band-Aid – and relatively decreased risk for complications such as infection or bleeding, and minimal to no scar.”
“Laser surgery also provides precision that ordinary surgical techniques cannot match. Despite the obvious obstacles, there is no reason such surgical techniques cannot be expanded someday to other internal cutaneous tumors, including GI tumors. To some extent this is happening already. Vascular lasers are being used to treat a bleeding disorder of the colon known as angiodysplasia. Cautious exploration of laser- and light-based treatments should be further explored as a means of sparing tissue and surgical morbidity.”
Dr. Ortiz disclosed that she has received grant funding from Sienna and Revance, as well as equipment from BTL, Invasix, and Sciton. She has received consulting fees from Alastin, Merz, and Sciton; honoraria from Alastin, Cutera, Invasix, and Sciton; and she holds ownership interest with Allergan. She also has served on the advisory boards for Alastin, Allergan, Invasix, Rodan + Fields, Sciton, Sienna, and Merz.
Dr. Avram disclosed that he serves on the medical advisory board of Sciton and on the scientific advisory boards of Sienna Biopharmaceuticals, Cytrellis, and Allergan. He is also a consultant for Merz Aesthetics, Allergan, Soliton, Invasix, and Revance and has intellectual property with Cytrellis. He also holds stock options with Cytrellis, Invasix, and Zalea.
DALLAS – One year after patients underwent treatment of basal cell carcinoma (BCC) with the 1064-nm Nd:YAG laser, no recurrences have occurred, according to early results from a study being conducted at two centers.
“ Arisa E. Ortiz, MD, said at the annual conference of the American Society for Laser Medicine and Surgery. “Clearance rates are comparable to or better than other topical modalities such as electrodesiccation and curettage and topical imiquimod. It’s a reasonable alternative for treatment patients with multiple tumors or those who are poor surgical candidates.”
In an ongoing study, she and Mathew M. Avram, MD, director of the Massachusetts General Hospital Dermatology Laser & Cosmetic Center, Boston, have treated 19 superficial, nodular, and pigmented BCC tumors in 11 patients 31-85 years of age. Tumor sizes ranged from 3 mm x 3 mm to 21 mm x 11 mm. Indications for laser treatment have included being a poor surgical candidate (one patient had a history of bleeding complications), having multiple tumors (one patient had Curry-Jones syndrome) – or simply wishing to not undergo surgery. “They didn’t want a surgical scar, or they didn’t want to limit their activity after surgery,” Dr. Ortiz said.
Patients underwent one 1064-nm Nd:YAG laser treatment. The anesthesia was 0.5% lidocaine with no epinephrine. Treatment settings were a 5-mm spot size delivered at a fluence of 140 J/cm2 in a pulse duration of 7-8 milliseconds. The number of pulses ranged from 14 to 36. The immediate endpoint was slight graying and slight contraction. “When you’re using the 1064-nm Nd:YAG for cosmetic purposes, you don’t want to see these endpoints, but we are treating skin cancer, so you do want to see some contraction and graying,” she said. The procedure was covered under insurance and billed as malignant destruction (CPT codes 17260-17266 and 17280-17283).
Dr. Ortiz reported that there have been no recurrences in the 11 patients at 1-year follow-up as determined by clinical observation. “There are many advantages to laser treatment of basal cell carcinoma,” she concluded. “There’s only one treatment visit, so you don’t have to come back for suture removal, and it’s a very quick treatment. There’s no significant downtime or limitation on activities, and there’s minimal wound care – just ointment and a Band-Aid – and relatively decreased risk for complications such as infection or bleeding, and minimal to no scar.”
“Laser surgery also provides precision that ordinary surgical techniques cannot match. Despite the obvious obstacles, there is no reason such surgical techniques cannot be expanded someday to other internal cutaneous tumors, including GI tumors. To some extent this is happening already. Vascular lasers are being used to treat a bleeding disorder of the colon known as angiodysplasia. Cautious exploration of laser- and light-based treatments should be further explored as a means of sparing tissue and surgical morbidity.”
Dr. Ortiz disclosed that she has received grant funding from Sienna and Revance, as well as equipment from BTL, Invasix, and Sciton. She has received consulting fees from Alastin, Merz, and Sciton; honoraria from Alastin, Cutera, Invasix, and Sciton; and she holds ownership interest with Allergan. She also has served on the advisory boards for Alastin, Allergan, Invasix, Rodan + Fields, Sciton, Sienna, and Merz.
Dr. Avram disclosed that he serves on the medical advisory board of Sciton and on the scientific advisory boards of Sienna Biopharmaceuticals, Cytrellis, and Allergan. He is also a consultant for Merz Aesthetics, Allergan, Soliton, Invasix, and Revance and has intellectual property with Cytrellis. He also holds stock options with Cytrellis, Invasix, and Zalea.
REPORTING FROM ASLMS 2018
Key clinical point: Clinicians can noninvasively treat certain basal cell carcinoma tumor subtypes with the 1064-nm Nd:YAG laser.
Major finding: After 1 year of follow-up, no recurrences of basal cell carcinoma have occurred.
Study details: A 1-year follow-up study of 19 BCC tumors in 11 patients 31 to 85 years of age who were treated with the 1064-nm Nd:YAG laser.
Disclosures: Dr. Ortiz disclosed that she has received grant funding from Sienna and Revance, as well as equipment from BTL, Invasix, and Sciton. She has received consulting fees from Alastin, Merz, and Sciton; honoraria from Alastin, Cutera, Invasix, and Sciton; and she holds ownership interest with Allergan. She also has served on the advisory boards for Alastin, Allergan, Invasix, Rodan + Fields, Sciton, Sienna, and Merz.
Dr. Avram disclosed that he serves on the medical advisory board of Sciton and on the scientific advisory boards of Sienna Biopharmaceuticals, Cytrellis, and Allergan. He is also a consultant for Merz Aesthetics, Allergan, Soliton, Invasix, and Revance and has intellectual property with Cytrellis. He also holds stock options with Cytrellis, Invasix, and Zalea.
Novel, noninvasive skin cancer detection device shows promise
DALLAS – An investigational device that couples laser spectroscopy with a machine-learning algorithm demonstrated a high sensitivity and specificity for discriminating skin cancers from benign lesions in real time, results from a single-center study showed.
“More than 5.4 million cases of nonmelanoma skin cancer were treated in 2012, but the accuracy of skin cancer screening prior to biopsy is pretty low, about 70%, and is individual dependent,” lead study author Sung Hyun Pyun, PhD, said at the annual conference of the American Society for Laser Medicine and Surgery. “There have been several in vivo skin cancer screening devices based on noninvasive techniques such as multispectral imaging, Raman spectroscopy, and electrical impedance spectroscopy, but their diagnostic accuracies were not sufficient for clinical use and could not be applied in real time.”
For the single-site study, carried out in Australia, the researchers collected 502 emission spectra from skin cancers confirmed with biopsy results. They also collected 1,429 emission spectra from benign lesions. They achieved a sensitivity of 92% and a specificity of 90% out of 1,931 spectral data sets. No adverse events occurred and no microscopic damage of the irradiated skin was observed.
“Pathologic diagnosis-based cancer detection is considered to be time- and labor-consuming, and can sometimes be individual dependent,” Dr. Pyun said. “Our real-time, noninvasive, in vivo skin cancer detection device demonstrated a high sensitivity and specificity for discriminating skin cancers from benign lesions.” He added that the device could be helpful in office-based cancer screening and real-time, on-site cancer detection during skin cancer surgeries.
Larger, multicenter studies of the device are being planned. Dr. Pyun holds ownership interests with Speclipse, and is an employee of the company.
DALLAS – An investigational device that couples laser spectroscopy with a machine-learning algorithm demonstrated a high sensitivity and specificity for discriminating skin cancers from benign lesions in real time, results from a single-center study showed.
“More than 5.4 million cases of nonmelanoma skin cancer were treated in 2012, but the accuracy of skin cancer screening prior to biopsy is pretty low, about 70%, and is individual dependent,” lead study author Sung Hyun Pyun, PhD, said at the annual conference of the American Society for Laser Medicine and Surgery. “There have been several in vivo skin cancer screening devices based on noninvasive techniques such as multispectral imaging, Raman spectroscopy, and electrical impedance spectroscopy, but their diagnostic accuracies were not sufficient for clinical use and could not be applied in real time.”
For the single-site study, carried out in Australia, the researchers collected 502 emission spectra from skin cancers confirmed with biopsy results. They also collected 1,429 emission spectra from benign lesions. They achieved a sensitivity of 92% and a specificity of 90% out of 1,931 spectral data sets. No adverse events occurred and no microscopic damage of the irradiated skin was observed.
“Pathologic diagnosis-based cancer detection is considered to be time- and labor-consuming, and can sometimes be individual dependent,” Dr. Pyun said. “Our real-time, noninvasive, in vivo skin cancer detection device demonstrated a high sensitivity and specificity for discriminating skin cancers from benign lesions.” He added that the device could be helpful in office-based cancer screening and real-time, on-site cancer detection during skin cancer surgeries.
Larger, multicenter studies of the device are being planned. Dr. Pyun holds ownership interests with Speclipse, and is an employee of the company.
DALLAS – An investigational device that couples laser spectroscopy with a machine-learning algorithm demonstrated a high sensitivity and specificity for discriminating skin cancers from benign lesions in real time, results from a single-center study showed.
“More than 5.4 million cases of nonmelanoma skin cancer were treated in 2012, but the accuracy of skin cancer screening prior to biopsy is pretty low, about 70%, and is individual dependent,” lead study author Sung Hyun Pyun, PhD, said at the annual conference of the American Society for Laser Medicine and Surgery. “There have been several in vivo skin cancer screening devices based on noninvasive techniques such as multispectral imaging, Raman spectroscopy, and electrical impedance spectroscopy, but their diagnostic accuracies were not sufficient for clinical use and could not be applied in real time.”
For the single-site study, carried out in Australia, the researchers collected 502 emission spectra from skin cancers confirmed with biopsy results. They also collected 1,429 emission spectra from benign lesions. They achieved a sensitivity of 92% and a specificity of 90% out of 1,931 spectral data sets. No adverse events occurred and no microscopic damage of the irradiated skin was observed.
“Pathologic diagnosis-based cancer detection is considered to be time- and labor-consuming, and can sometimes be individual dependent,” Dr. Pyun said. “Our real-time, noninvasive, in vivo skin cancer detection device demonstrated a high sensitivity and specificity for discriminating skin cancers from benign lesions.” He added that the device could be helpful in office-based cancer screening and real-time, on-site cancer detection during skin cancer surgeries.
Larger, multicenter studies of the device are being planned. Dr. Pyun holds ownership interests with Speclipse, and is an employee of the company.
REPORTING FROM ASLMS 2018
Key clinical point: A novel device that uses spectroscopy and machine-learning algorithms was found to be a promising tool for the detection of skin cancer.
Major finding: Out of 1,931 spectral data sets, the device achieved a sensitivity of 92% and a specificity of 90%.
Study details: A single-center analysis of 502 emission spectra from skin cancers confirmed with biopsy results.
Disclosures: Dr. Pyun holds ownership interests with Speclipse and is an employee of the company.
NHLBI seeks to accelerate hemostasis/thrombosis research
SAN DIEGO – The National Heart, Lung, and Blood Institute is looking to jump-start research into hemostasis and thrombosis. Donna DiMichele, MD, offered two reasons for the research push.
“The first is to stimulate research in areas that are undersubscribed through investigator-initiated research,” Dr. DiMichele, deputy director of the NHLBI’s Division of Blood Diseases and Resources, said at the biennial summit of the Thrombosis & Hemostasis Societies of North America. “We also do it sometimes to steer research in directions that are not developing organically through investigator-initiated efforts. In hemostasis and thrombosis, 50% of the investigator-led research is basic in nature. Nonetheless, there were several basic research initiatives that NHLBI released in the last few years that stimulated the field in a new direction.”
The centers will be required to look beyond current active science disciplines in this field, to include emerging sciences and technologies not currently being exploited in this research area. The initiative is also intended to cross-train the next generation of physicians/scientists with interdisciplinary skill sets. “The research teams with successful applications are going to begin their work by the summer of 2018, and hopefully we’ll soon gain some new insights into Factor VIII immunogenicity,” Dr. DiMichele said.
One novel scientific area that successful applicants will be able to take advantage of is the Trans-Omics for Precision Medicine Program (TOPMed). Launched in 2014, this program facilitates whole-genome sequencing across cohorts in heart, lung, blood, and sleep science. TOPMed now includes more than 120,000 whole genomes, with more than 5,000 of those in hemophilia.
In basic science, two NHLBI-funded initiatives aim to improve the understanding of thrombosis.
One, Sex Hormone Induced Thromboembolism in Premenopausal Women (R61/R33), is meant to elucidate the mechanisms by which female sex hormones and sex hormone-based therapies can increase the risk of venous and arterial thromboembolism in premenopausal women. The other initiative, Consortium Linking Oncology with Thrombosis (U01), is aimed at encouraging studies in individual cancer types that expand investigation into the intersection between cancer and thrombotic pathways. It also aims to help researchers identify and develop biomarkers of thrombotic risk or cancer progression, and new strategies for preventing or treating the deleterious interplay between cancer, cancer therapy, and hemostasis/thrombosis.
In the translational research arena, the NHLBI released an initiative on Perinatal Stroke (R01) in 2017. It solicits applications that propose basic and/or translational research studies related to the developing neurovascular unit, perinatal injury/repair response, and/or stroke-related etiologies and risk factors. The purpose is to stimulate research that will identify therapeutic targets in perinatal stroke.
Other NHLBI-sponsored efforts include the Trans-Agency Research Consortium for Trauma-Induced Coagulopathy (TACTIC), as well as the Translational Research Centers in Thrombotic and Hemostatic Disorders program, which set out to enhance the translation of basic research discoveries that could lead to improved prevention, diagnosis, and treatment for thrombotic and hemostatic disorders. This program ended but it led to the development of several projects that are moving into the commercialization phase.
Finally, to further stimulate research in FVIII immunogenicity, on May 15-16, 2018, the NHBLI will host a free workshop entitled “Factor VIII Inhibitors: Generating a Blueprint for Future Research.” For information, visit https://factorviiinhibitors.eventbrite.com.
Dr. DiMichele reported having no financial disclosures.
SAN DIEGO – The National Heart, Lung, and Blood Institute is looking to jump-start research into hemostasis and thrombosis. Donna DiMichele, MD, offered two reasons for the research push.
“The first is to stimulate research in areas that are undersubscribed through investigator-initiated research,” Dr. DiMichele, deputy director of the NHLBI’s Division of Blood Diseases and Resources, said at the biennial summit of the Thrombosis & Hemostasis Societies of North America. “We also do it sometimes to steer research in directions that are not developing organically through investigator-initiated efforts. In hemostasis and thrombosis, 50% of the investigator-led research is basic in nature. Nonetheless, there were several basic research initiatives that NHLBI released in the last few years that stimulated the field in a new direction.”
The centers will be required to look beyond current active science disciplines in this field, to include emerging sciences and technologies not currently being exploited in this research area. The initiative is also intended to cross-train the next generation of physicians/scientists with interdisciplinary skill sets. “The research teams with successful applications are going to begin their work by the summer of 2018, and hopefully we’ll soon gain some new insights into Factor VIII immunogenicity,” Dr. DiMichele said.
One novel scientific area that successful applicants will be able to take advantage of is the Trans-Omics for Precision Medicine Program (TOPMed). Launched in 2014, this program facilitates whole-genome sequencing across cohorts in heart, lung, blood, and sleep science. TOPMed now includes more than 120,000 whole genomes, with more than 5,000 of those in hemophilia.
In basic science, two NHLBI-funded initiatives aim to improve the understanding of thrombosis.
One, Sex Hormone Induced Thromboembolism in Premenopausal Women (R61/R33), is meant to elucidate the mechanisms by which female sex hormones and sex hormone-based therapies can increase the risk of venous and arterial thromboembolism in premenopausal women. The other initiative, Consortium Linking Oncology with Thrombosis (U01), is aimed at encouraging studies in individual cancer types that expand investigation into the intersection between cancer and thrombotic pathways. It also aims to help researchers identify and develop biomarkers of thrombotic risk or cancer progression, and new strategies for preventing or treating the deleterious interplay between cancer, cancer therapy, and hemostasis/thrombosis.
In the translational research arena, the NHLBI released an initiative on Perinatal Stroke (R01) in 2017. It solicits applications that propose basic and/or translational research studies related to the developing neurovascular unit, perinatal injury/repair response, and/or stroke-related etiologies and risk factors. The purpose is to stimulate research that will identify therapeutic targets in perinatal stroke.
Other NHLBI-sponsored efforts include the Trans-Agency Research Consortium for Trauma-Induced Coagulopathy (TACTIC), as well as the Translational Research Centers in Thrombotic and Hemostatic Disorders program, which set out to enhance the translation of basic research discoveries that could lead to improved prevention, diagnosis, and treatment for thrombotic and hemostatic disorders. This program ended but it led to the development of several projects that are moving into the commercialization phase.
Finally, to further stimulate research in FVIII immunogenicity, on May 15-16, 2018, the NHBLI will host a free workshop entitled “Factor VIII Inhibitors: Generating a Blueprint for Future Research.” For information, visit https://factorviiinhibitors.eventbrite.com.
Dr. DiMichele reported having no financial disclosures.
SAN DIEGO – The National Heart, Lung, and Blood Institute is looking to jump-start research into hemostasis and thrombosis. Donna DiMichele, MD, offered two reasons for the research push.
“The first is to stimulate research in areas that are undersubscribed through investigator-initiated research,” Dr. DiMichele, deputy director of the NHLBI’s Division of Blood Diseases and Resources, said at the biennial summit of the Thrombosis & Hemostasis Societies of North America. “We also do it sometimes to steer research in directions that are not developing organically through investigator-initiated efforts. In hemostasis and thrombosis, 50% of the investigator-led research is basic in nature. Nonetheless, there were several basic research initiatives that NHLBI released in the last few years that stimulated the field in a new direction.”
The centers will be required to look beyond current active science disciplines in this field, to include emerging sciences and technologies not currently being exploited in this research area. The initiative is also intended to cross-train the next generation of physicians/scientists with interdisciplinary skill sets. “The research teams with successful applications are going to begin their work by the summer of 2018, and hopefully we’ll soon gain some new insights into Factor VIII immunogenicity,” Dr. DiMichele said.
One novel scientific area that successful applicants will be able to take advantage of is the Trans-Omics for Precision Medicine Program (TOPMed). Launched in 2014, this program facilitates whole-genome sequencing across cohorts in heart, lung, blood, and sleep science. TOPMed now includes more than 120,000 whole genomes, with more than 5,000 of those in hemophilia.
In basic science, two NHLBI-funded initiatives aim to improve the understanding of thrombosis.
One, Sex Hormone Induced Thromboembolism in Premenopausal Women (R61/R33), is meant to elucidate the mechanisms by which female sex hormones and sex hormone-based therapies can increase the risk of venous and arterial thromboembolism in premenopausal women. The other initiative, Consortium Linking Oncology with Thrombosis (U01), is aimed at encouraging studies in individual cancer types that expand investigation into the intersection between cancer and thrombotic pathways. It also aims to help researchers identify and develop biomarkers of thrombotic risk or cancer progression, and new strategies for preventing or treating the deleterious interplay between cancer, cancer therapy, and hemostasis/thrombosis.
In the translational research arena, the NHLBI released an initiative on Perinatal Stroke (R01) in 2017. It solicits applications that propose basic and/or translational research studies related to the developing neurovascular unit, perinatal injury/repair response, and/or stroke-related etiologies and risk factors. The purpose is to stimulate research that will identify therapeutic targets in perinatal stroke.
Other NHLBI-sponsored efforts include the Trans-Agency Research Consortium for Trauma-Induced Coagulopathy (TACTIC), as well as the Translational Research Centers in Thrombotic and Hemostatic Disorders program, which set out to enhance the translation of basic research discoveries that could lead to improved prevention, diagnosis, and treatment for thrombotic and hemostatic disorders. This program ended but it led to the development of several projects that are moving into the commercialization phase.
Finally, to further stimulate research in FVIII immunogenicity, on May 15-16, 2018, the NHBLI will host a free workshop entitled “Factor VIII Inhibitors: Generating a Blueprint for Future Research.” For information, visit https://factorviiinhibitors.eventbrite.com.
Dr. DiMichele reported having no financial disclosures.
EXPERT ANALYSIS FROM THSNA 2018
Does warfarin cause acute kidney injury?
SAN DIEGO – Patients with chronic kidney disease (CKD) and those on renin angiotensin system inhibitors and/or diuretics should have their renal function monitored during periods of overanticoagulation, results from a large retrospective study suggest.
“Unfortunately, warfarin-related nephropathy is quite hard to study,” Hugh Traquair, MD, the study’s lead author, said in an interview at the biennial summit of the Thrombosis & Hemostasis Societies of North America. “The best way to establish diagnosis is with a kidney biopsy. No one is very keen to stick a needle into a kidney when someone’s overanticoagulated. It’s been observed previously that acute kidney injury related to over-anticoagulation is more common in people with CKD, but we don’t know more about risk factors.”
The primary outcome was AKI, defined as an acute increase in creatinine of greater than 26.5 micromol/L within 7-14 days of an INR 4 or greater. The secondary outcome was creatinine level within 3 months of the abnormal INR. The researchers excluded patients with AKI due to another cause, and those who lacked a creatinine level at baseline, within 7-14 days of an INR of 4 or greater, and/or at 3 months.
The median age of the 292 patients was 79 years, 55% were male, 30% were taking aspirin, and 77% were taking renin angiotensin inhibitors and/or diuretics. The control group consisted of 93 patients with a 12-month time in therapeutic range of 100%. The median age of controls was 68 years, 67% were male, and 9% had CKD. None of the controls had an AKI, said Dr. Traquair, a second-year internal medicine resident in the department of medicine at McMaster University.
Of the 292 patients with an INR of 4 or greater, 13% had an AKI, and the incidence of AKI was significantly higher in the CKD patients, compared with those who had a normal baseline creatinine level (19% vs. 10%; odds ratio, 2.1; P less than .05).
In a binomial logistic regression model, diuretic use was the only significant predictor of AKI (OR 3.4; P less than .05). The researchers also found that of the 52 patients with an INR of 4 or greater who did not use renin angiotensin system inhibitors and/or diuretics and did not have CKD, only 1 had an AKI (2%).
“We don’t know that all of these episodes of AKI are related to warfarin, but we do see a definite increase of AKI after an episode of overanticoagulation (an INR greater than 4),” Dr. Traquair said. “In patients who are at risk for AKI, monitoring their kidney function after an episode of overanticoagulation is probably warranted.”
Dr. Traquair reported having no financial disclosures.
SOURCE: Traquair H et al. THSNA 2018, Poster 79.
SAN DIEGO – Patients with chronic kidney disease (CKD) and those on renin angiotensin system inhibitors and/or diuretics should have their renal function monitored during periods of overanticoagulation, results from a large retrospective study suggest.
“Unfortunately, warfarin-related nephropathy is quite hard to study,” Hugh Traquair, MD, the study’s lead author, said in an interview at the biennial summit of the Thrombosis & Hemostasis Societies of North America. “The best way to establish diagnosis is with a kidney biopsy. No one is very keen to stick a needle into a kidney when someone’s overanticoagulated. It’s been observed previously that acute kidney injury related to over-anticoagulation is more common in people with CKD, but we don’t know more about risk factors.”
The primary outcome was AKI, defined as an acute increase in creatinine of greater than 26.5 micromol/L within 7-14 days of an INR 4 or greater. The secondary outcome was creatinine level within 3 months of the abnormal INR. The researchers excluded patients with AKI due to another cause, and those who lacked a creatinine level at baseline, within 7-14 days of an INR of 4 or greater, and/or at 3 months.
The median age of the 292 patients was 79 years, 55% were male, 30% were taking aspirin, and 77% were taking renin angiotensin inhibitors and/or diuretics. The control group consisted of 93 patients with a 12-month time in therapeutic range of 100%. The median age of controls was 68 years, 67% were male, and 9% had CKD. None of the controls had an AKI, said Dr. Traquair, a second-year internal medicine resident in the department of medicine at McMaster University.
Of the 292 patients with an INR of 4 or greater, 13% had an AKI, and the incidence of AKI was significantly higher in the CKD patients, compared with those who had a normal baseline creatinine level (19% vs. 10%; odds ratio, 2.1; P less than .05).
In a binomial logistic regression model, diuretic use was the only significant predictor of AKI (OR 3.4; P less than .05). The researchers also found that of the 52 patients with an INR of 4 or greater who did not use renin angiotensin system inhibitors and/or diuretics and did not have CKD, only 1 had an AKI (2%).
“We don’t know that all of these episodes of AKI are related to warfarin, but we do see a definite increase of AKI after an episode of overanticoagulation (an INR greater than 4),” Dr. Traquair said. “In patients who are at risk for AKI, monitoring their kidney function after an episode of overanticoagulation is probably warranted.”
Dr. Traquair reported having no financial disclosures.
SOURCE: Traquair H et al. THSNA 2018, Poster 79.
SAN DIEGO – Patients with chronic kidney disease (CKD) and those on renin angiotensin system inhibitors and/or diuretics should have their renal function monitored during periods of overanticoagulation, results from a large retrospective study suggest.
“Unfortunately, warfarin-related nephropathy is quite hard to study,” Hugh Traquair, MD, the study’s lead author, said in an interview at the biennial summit of the Thrombosis & Hemostasis Societies of North America. “The best way to establish diagnosis is with a kidney biopsy. No one is very keen to stick a needle into a kidney when someone’s overanticoagulated. It’s been observed previously that acute kidney injury related to over-anticoagulation is more common in people with CKD, but we don’t know more about risk factors.”
The primary outcome was AKI, defined as an acute increase in creatinine of greater than 26.5 micromol/L within 7-14 days of an INR 4 or greater. The secondary outcome was creatinine level within 3 months of the abnormal INR. The researchers excluded patients with AKI due to another cause, and those who lacked a creatinine level at baseline, within 7-14 days of an INR of 4 or greater, and/or at 3 months.
The median age of the 292 patients was 79 years, 55% were male, 30% were taking aspirin, and 77% were taking renin angiotensin inhibitors and/or diuretics. The control group consisted of 93 patients with a 12-month time in therapeutic range of 100%. The median age of controls was 68 years, 67% were male, and 9% had CKD. None of the controls had an AKI, said Dr. Traquair, a second-year internal medicine resident in the department of medicine at McMaster University.
Of the 292 patients with an INR of 4 or greater, 13% had an AKI, and the incidence of AKI was significantly higher in the CKD patients, compared with those who had a normal baseline creatinine level (19% vs. 10%; odds ratio, 2.1; P less than .05).
In a binomial logistic regression model, diuretic use was the only significant predictor of AKI (OR 3.4; P less than .05). The researchers also found that of the 52 patients with an INR of 4 or greater who did not use renin angiotensin system inhibitors and/or diuretics and did not have CKD, only 1 had an AKI (2%).
“We don’t know that all of these episodes of AKI are related to warfarin, but we do see a definite increase of AKI after an episode of overanticoagulation (an INR greater than 4),” Dr. Traquair said. “In patients who are at risk for AKI, monitoring their kidney function after an episode of overanticoagulation is probably warranted.”
Dr. Traquair reported having no financial disclosures.
SOURCE: Traquair H et al. THSNA 2018, Poster 79.
REPORTING FROM THSNA 2018
Key clinical point:
Major finding: Among patients with warfarin anticoagulation, 13% had an acute kidney injury.
Study details: A retrospective study of 292 patients with an INR of 4.0 or greater who were treated between 2007 and 2017.
Disclosures: Dr. Traquair reported having no financial disclosures.
Source: Traquair H et al. THSNA 2018, Poster 79.
Novel dermal coring device effective for facial rejuvenation without using thermal energy
DALLAS – according to preliminary results from an ongoing study.
“This differs from laser treatment in the sense that there’s no thermal injury and it takes a deep core approach, along the lines of what you might expect from a punch biopsy,” lead study author Roy G. Geronemus, MD, said at the annual conference of the American Society for Laser Medicine and Surgery. “The device causes microscale excisions below the size that causes scar. It’s mechanical only, without the use of any thermal energy. There is quantitative and directional reduction in area of skin. This leads to wrinkle improvement, tightening, smoothing of lax skin, and skin rejuvenation.”
The average age of subjects was 64 years, and all had Fitzpatrick types II or III skin. No unanticipated adverse events or serious adverse events were observed, and histology from 3 subjects showed an excellent healing profile and no scarring. The average pain during treatment was 0.36 on the 0-10 Wong-Baker scale.
Interim 90-day data demonstrated that 87% of 30 cheek areas had 1, 2, or 3 levels of improvement in moderate to severe cheek wrinkles on the Lemperle scale, according to primary investigator assessment. Investigators and subjects scored “improved to very much improved” in 93% of patients per the Global Aesthetic Improvement Scale, and 80% of the patients reported being “satisfied to extremely satisfied” with their aesthetic results.
Dr. Geronemus noted that, while it takes 2 to 7 days for wounds to close following ablative procedures, wounds close in about 10 minutes following microexcisional treatment, which possibly leads to faster healing of tissue. “Most people expect some downtime to achieve effective, long-lasting results,” he said. “The mean downtime was 3.8 days; 75% of subjects did not miss work, and 46% did not miss any social or leisure activities.”
To date, 79 subjects have been treated and a 90-day pivotal study is under way. Based on the clinical data to date, he said, “the new technique offers the ability to remove a significant amount of damaged, lax skin without concern of scarring or pigmentary change.”
Dr. Geronemus reported having served on the advisory board or as an investigator for Cynosure, Syneron Candela, Cutera, Revance Therapeutics, Allergan, Cytrellis Biosystems, the New York Stem Cell Foundation, among others. He also holds ownership interests with Cytrellis, the company that developed the coring device.
[email protected]
DALLAS – according to preliminary results from an ongoing study.
“This differs from laser treatment in the sense that there’s no thermal injury and it takes a deep core approach, along the lines of what you might expect from a punch biopsy,” lead study author Roy G. Geronemus, MD, said at the annual conference of the American Society for Laser Medicine and Surgery. “The device causes microscale excisions below the size that causes scar. It’s mechanical only, without the use of any thermal energy. There is quantitative and directional reduction in area of skin. This leads to wrinkle improvement, tightening, smoothing of lax skin, and skin rejuvenation.”
The average age of subjects was 64 years, and all had Fitzpatrick types II or III skin. No unanticipated adverse events or serious adverse events were observed, and histology from 3 subjects showed an excellent healing profile and no scarring. The average pain during treatment was 0.36 on the 0-10 Wong-Baker scale.
Interim 90-day data demonstrated that 87% of 30 cheek areas had 1, 2, or 3 levels of improvement in moderate to severe cheek wrinkles on the Lemperle scale, according to primary investigator assessment. Investigators and subjects scored “improved to very much improved” in 93% of patients per the Global Aesthetic Improvement Scale, and 80% of the patients reported being “satisfied to extremely satisfied” with their aesthetic results.
Dr. Geronemus noted that, while it takes 2 to 7 days for wounds to close following ablative procedures, wounds close in about 10 minutes following microexcisional treatment, which possibly leads to faster healing of tissue. “Most people expect some downtime to achieve effective, long-lasting results,” he said. “The mean downtime was 3.8 days; 75% of subjects did not miss work, and 46% did not miss any social or leisure activities.”
To date, 79 subjects have been treated and a 90-day pivotal study is under way. Based on the clinical data to date, he said, “the new technique offers the ability to remove a significant amount of damaged, lax skin without concern of scarring or pigmentary change.”
Dr. Geronemus reported having served on the advisory board or as an investigator for Cynosure, Syneron Candela, Cutera, Revance Therapeutics, Allergan, Cytrellis Biosystems, the New York Stem Cell Foundation, among others. He also holds ownership interests with Cytrellis, the company that developed the coring device.
[email protected]
DALLAS – according to preliminary results from an ongoing study.
“This differs from laser treatment in the sense that there’s no thermal injury and it takes a deep core approach, along the lines of what you might expect from a punch biopsy,” lead study author Roy G. Geronemus, MD, said at the annual conference of the American Society for Laser Medicine and Surgery. “The device causes microscale excisions below the size that causes scar. It’s mechanical only, without the use of any thermal energy. There is quantitative and directional reduction in area of skin. This leads to wrinkle improvement, tightening, smoothing of lax skin, and skin rejuvenation.”
The average age of subjects was 64 years, and all had Fitzpatrick types II or III skin. No unanticipated adverse events or serious adverse events were observed, and histology from 3 subjects showed an excellent healing profile and no scarring. The average pain during treatment was 0.36 on the 0-10 Wong-Baker scale.
Interim 90-day data demonstrated that 87% of 30 cheek areas had 1, 2, or 3 levels of improvement in moderate to severe cheek wrinkles on the Lemperle scale, according to primary investigator assessment. Investigators and subjects scored “improved to very much improved” in 93% of patients per the Global Aesthetic Improvement Scale, and 80% of the patients reported being “satisfied to extremely satisfied” with their aesthetic results.
Dr. Geronemus noted that, while it takes 2 to 7 days for wounds to close following ablative procedures, wounds close in about 10 minutes following microexcisional treatment, which possibly leads to faster healing of tissue. “Most people expect some downtime to achieve effective, long-lasting results,” he said. “The mean downtime was 3.8 days; 75% of subjects did not miss work, and 46% did not miss any social or leisure activities.”
To date, 79 subjects have been treated and a 90-day pivotal study is under way. Based on the clinical data to date, he said, “the new technique offers the ability to remove a significant amount of damaged, lax skin without concern of scarring or pigmentary change.”
Dr. Geronemus reported having served on the advisory board or as an investigator for Cynosure, Syneron Candela, Cutera, Revance Therapeutics, Allergan, Cytrellis Biosystems, the New York Stem Cell Foundation, among others. He also holds ownership interests with Cytrellis, the company that developed the coring device.
[email protected]
REPORTING FROM ASLMS 2018
Key clinical point: A novel dermal microexcisional device has been designed to perform facial rejuvenation without the use of thermal energy.
Major finding: Interim 90-day data demonstrated that 87% of 30 cheek areas had 1, 2, or 3 levels of improvement in moderate to severe cheek wrinkles on the Lemperle scale.Study details: A multicenter study of 23 women who were treated bilaterally in the mid- to lower face with the 22-gauge coring device.
Disclosures: Dr. Geronemus reported having served on the advisory board or as an investigator for Cynosure, Syneron Candela, Cutera, Revance Therapeutics, Allergan, Cytrellis Biosystems, the New York Stem Cell Foundation, among others. He also holds ownership interests with Cytrellis.
Consider caregiver oral health for children with bleeding disorders
SAN DIEGO – Caregiver oral health status is an identifiable risk factor that could be used to screen for poor oral health among children and young adults with bleeding disorders, results from a single-center suggest.
“We ask parents one simple question: ‘Have you had a cavity in the last year?’ If they say yes, we would be more concerned that their children would be more likely to have poor oral health,” Elizabeth Hastie said in an interview during a poster session at the biennial summit of the Thrombosis & Hemostasis Societies of North America.
Proper oral health may prevent joint disease and other conditions that predispose patients to bleeds, according to Ms. Hastie, a fourth-year medical student at Emory University, Atlanta. However, of the 147 hemophilia treatment centers in the United States, just 30% have a dentist on staff, while 90% of centers have expressed interest in increasing patient education in oral health.
In an effort to evaluate the dental habits, needs, and oral health issues of children and young adults up to age 18 with bleeding disorders, Ms. Hastie and her associates conducted a cross-sectional study of 226 patients who were evaluated by a staff dental hygienist at Children’s Healthcare of Atlanta Comprehensive Bleeding Disorders Clinic from May 2016 to October 2017.
The evaluation consisted of a 14-question survey derived from the American Academy of Pediatric Dentistry Caries–Risk Assessment Tool completed by the primary caregiver present during the visit and oral screening. The researchers extracted demographic and clinical characteristics from the patient’s chart and included age, race, county of residence, and bleeding disorder type and severity.
Nearly half of the patients (44%) reported they did not brush their teeth twice a day. Children younger than age 5 years were more likely to not brush their teeth twice a day, compared with children aged 5-14 years and young adults aged 15-18 years (57% vs. 44% and 31% respectively, P = .08).
More than one-quarter of patients (27%) reported not having a current dentist and 15% reported specific challenges with access to dental care including burdens related to distance, insurance coverage, and finding a provider willing to treat in the setting of their medical condition. Those who were Medicaid eligible or of low socioeconomic status were significantly more likely to report dental care access issues, compared with other patients (20% vs. 9%; P = .01).
Oral screening performed by the dental hygienist demonstrated significant oral pathology: 89% of patients had plaque accumulation, 57% had white spots or decalcifications, 37% had gingivitis, and 8% had suspicious lesions suggestive of dental caries.
The researchers also found that having a caregiver with active oral disease in the past 12 months increased the odds of suspicious lesions (odds ratio, 4.34), increased the odds of gingivitis (OR, 3.80), and decreased the odds of the patients’ brushing their teeth at least twice per day (OR, 0.17).
“Hopefully, if we can target those high-risk patients in clinic, we could reduce costs, the number of bleeds, the number of products and factor used, and potentially even morbidity in the future,” Ms. Hastie said.
She acknowledged certain limitations of the study, including its single-center design and the fact that a dental hygienist performed the majority of evaluations. She reported having no financial disclosures.
SAN DIEGO – Caregiver oral health status is an identifiable risk factor that could be used to screen for poor oral health among children and young adults with bleeding disorders, results from a single-center suggest.
“We ask parents one simple question: ‘Have you had a cavity in the last year?’ If they say yes, we would be more concerned that their children would be more likely to have poor oral health,” Elizabeth Hastie said in an interview during a poster session at the biennial summit of the Thrombosis & Hemostasis Societies of North America.
Proper oral health may prevent joint disease and other conditions that predispose patients to bleeds, according to Ms. Hastie, a fourth-year medical student at Emory University, Atlanta. However, of the 147 hemophilia treatment centers in the United States, just 30% have a dentist on staff, while 90% of centers have expressed interest in increasing patient education in oral health.
In an effort to evaluate the dental habits, needs, and oral health issues of children and young adults up to age 18 with bleeding disorders, Ms. Hastie and her associates conducted a cross-sectional study of 226 patients who were evaluated by a staff dental hygienist at Children’s Healthcare of Atlanta Comprehensive Bleeding Disorders Clinic from May 2016 to October 2017.
The evaluation consisted of a 14-question survey derived from the American Academy of Pediatric Dentistry Caries–Risk Assessment Tool completed by the primary caregiver present during the visit and oral screening. The researchers extracted demographic and clinical characteristics from the patient’s chart and included age, race, county of residence, and bleeding disorder type and severity.
Nearly half of the patients (44%) reported they did not brush their teeth twice a day. Children younger than age 5 years were more likely to not brush their teeth twice a day, compared with children aged 5-14 years and young adults aged 15-18 years (57% vs. 44% and 31% respectively, P = .08).
More than one-quarter of patients (27%) reported not having a current dentist and 15% reported specific challenges with access to dental care including burdens related to distance, insurance coverage, and finding a provider willing to treat in the setting of their medical condition. Those who were Medicaid eligible or of low socioeconomic status were significantly more likely to report dental care access issues, compared with other patients (20% vs. 9%; P = .01).
Oral screening performed by the dental hygienist demonstrated significant oral pathology: 89% of patients had plaque accumulation, 57% had white spots or decalcifications, 37% had gingivitis, and 8% had suspicious lesions suggestive of dental caries.
The researchers also found that having a caregiver with active oral disease in the past 12 months increased the odds of suspicious lesions (odds ratio, 4.34), increased the odds of gingivitis (OR, 3.80), and decreased the odds of the patients’ brushing their teeth at least twice per day (OR, 0.17).
“Hopefully, if we can target those high-risk patients in clinic, we could reduce costs, the number of bleeds, the number of products and factor used, and potentially even morbidity in the future,” Ms. Hastie said.
She acknowledged certain limitations of the study, including its single-center design and the fact that a dental hygienist performed the majority of evaluations. She reported having no financial disclosures.
SAN DIEGO – Caregiver oral health status is an identifiable risk factor that could be used to screen for poor oral health among children and young adults with bleeding disorders, results from a single-center suggest.
“We ask parents one simple question: ‘Have you had a cavity in the last year?’ If they say yes, we would be more concerned that their children would be more likely to have poor oral health,” Elizabeth Hastie said in an interview during a poster session at the biennial summit of the Thrombosis & Hemostasis Societies of North America.
Proper oral health may prevent joint disease and other conditions that predispose patients to bleeds, according to Ms. Hastie, a fourth-year medical student at Emory University, Atlanta. However, of the 147 hemophilia treatment centers in the United States, just 30% have a dentist on staff, while 90% of centers have expressed interest in increasing patient education in oral health.
In an effort to evaluate the dental habits, needs, and oral health issues of children and young adults up to age 18 with bleeding disorders, Ms. Hastie and her associates conducted a cross-sectional study of 226 patients who were evaluated by a staff dental hygienist at Children’s Healthcare of Atlanta Comprehensive Bleeding Disorders Clinic from May 2016 to October 2017.
The evaluation consisted of a 14-question survey derived from the American Academy of Pediatric Dentistry Caries–Risk Assessment Tool completed by the primary caregiver present during the visit and oral screening. The researchers extracted demographic and clinical characteristics from the patient’s chart and included age, race, county of residence, and bleeding disorder type and severity.
Nearly half of the patients (44%) reported they did not brush their teeth twice a day. Children younger than age 5 years were more likely to not brush their teeth twice a day, compared with children aged 5-14 years and young adults aged 15-18 years (57% vs. 44% and 31% respectively, P = .08).
More than one-quarter of patients (27%) reported not having a current dentist and 15% reported specific challenges with access to dental care including burdens related to distance, insurance coverage, and finding a provider willing to treat in the setting of their medical condition. Those who were Medicaid eligible or of low socioeconomic status were significantly more likely to report dental care access issues, compared with other patients (20% vs. 9%; P = .01).
Oral screening performed by the dental hygienist demonstrated significant oral pathology: 89% of patients had plaque accumulation, 57% had white spots or decalcifications, 37% had gingivitis, and 8% had suspicious lesions suggestive of dental caries.
The researchers also found that having a caregiver with active oral disease in the past 12 months increased the odds of suspicious lesions (odds ratio, 4.34), increased the odds of gingivitis (OR, 3.80), and decreased the odds of the patients’ brushing their teeth at least twice per day (OR, 0.17).
“Hopefully, if we can target those high-risk patients in clinic, we could reduce costs, the number of bleeds, the number of products and factor used, and potentially even morbidity in the future,” Ms. Hastie said.
She acknowledged certain limitations of the study, including its single-center design and the fact that a dental hygienist performed the majority of evaluations. She reported having no financial disclosures.
REPORTING FROM THSNA 2018
Key clinical point:
Major finding: Having a caregiver with active oral disease in the past 12 months increased the odds of the child having a suspicious lesion (OR 4.34) and gingivitis (OR 3.80).
Study details: A cross-sectional study of 226 pediatric patients who were evaluated by a dental hygienist.
Disclosures: Ms. Hastie reported having no financial disclosures.
Source: Hastie E et al. THSNA 2018, Poster 150.